Non Employee Incident Report printable pdf download

Non Employee Incident Report

Non-Employee Incident Report

In case of an emergency call:

UNC Police Department – 911 or 351-2245

PURPOSE

Non-employee injuries and incidents may occur on campus and can involve students

and visitors. Types of incidents may include, but not limited to, a student injured in a

classroom, a campus visitor who falls down and is injured, or a student or visitor injured

at an event.

DEPARTMENTS

When a department on campus assists with a non-employee incident, faculty or staff

shall have the student or visitor fill out a Non-Employee Injury / Incident Report form.

Note: A UNC employee injury / incident shall be reported to Human Resources and the employee

will complete the Employee Injury/Illness Report. This would include students who are injured

during UNC employment.

NON-EMPLOYEE INJURY OR ILLNESS REPORT

When a Non-Employee Incident Report form is completed, the department shall keep a

copy for their records (for three years) and the original form shall be sent to

Environmental Health & Safety.

Submit the Non–Employee Injury or Illness Report form to:

Original Copy

Environmental Health and Safety

501 20

Street, Campus Box 57

Greeley, CO 80639

Fax to 351-1170

Non Employee Incident Report